Key result
PROMPT training linked to ~88% higher shoulder dystocia diagnoses alongside eliminated permanent brachial plexus injuries.
Why the study?
The study was conducted to test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears in shoulder dystocia.
Does PROMPT training reduce permanent brachial plexus palsy and perineal tears in vaginal deliveries?
Cohort (n=22,640)
No
Does PROMPT training reduce permanent brachial plexus palsy and perineal tears in vaginal deliveries?
Odds Ratio: 1.88 (95% CI 1.14–3.09)
Absolute Event Rate: 0.5% vs 0.27%
p-value: p=0.017
Multiprofessional obstetric training (PROMPT) can improve the management of shoulder dystocia and eliminate permanent brachial plexus injuries, though it may not prevent severe perineal tears.
PROMPT training was associated with zero permanent brachial plexus injuries; leaves open whether simulation improves net obstetric outcomes without randomized confirmation.
Objective . To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears. Design . A prospective/retrospective cohort study. Setting . Hanover Medical School, Germany. Population/Sample . A self‐selected population. Methods . The training period is from November 9 th , 2017, until December 31 st , 2019; control: January 1 st , 2004, until November 8 th , 2017. Main Outcome Measures . Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia. Results . There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) (( p = 0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) ( p = 0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) ( p = 0.23). However, adverse outcomes after one year were zero. McRoberts’ manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) (( p = 0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) ( p = 0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) (( p < 0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) ( p = 0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions . PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.
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Papageorgiou et al. (2024) conducted a cohort in Shoulder dystocia and related birth injuries (n=22,640). PROMPT (Practical Obstetric Multiprofessional Training) vs. Historical control period (2004-2017) before PROMPT implementation was evaluated on Shoulder dystocia diagnosis (OR 1.88, 95% CI 1.14-3.09, p=0.017). PROMPT training was associated with an increased diagnosis of shoulder dystocia (OR 1.88) and a reduction in permanent brachial plexus injuries to 0%, but an increase in perineal tears III°/IV°.
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